Pediatric Nephrology

, Volume 30, Issue 1, pp 103–111 | Cite as

Indications, technique, and outcome of therapeutic apheresis in European pediatric nephrology units

  • Fabio Paglialonga
  • Claus Peter Schmitt
  • Rukshana Shroff
  • Karel Vondrak
  • Christoph Aufricht
  • Alan Rees Watson
  • Gema Ariceta
  • Michael Fischbach
  • Gunter Klaus
  • Tuula Holtta
  • Sevcan A. Bakkaloglu
  • Alexandra Zurowska
  • Augustina Jankauskiene
  • Johan Vande Walle
  • Betti Schaefer
  • Elizabeth Wright
  • Roy Connell
  • Alberto Edefonti
Original Article

Abstract

Background

Few observations on apheresis in pediatric nephrology units have been published.

Methods

This retrospective study involved children ≤18 years undergoing plasma exchange (PE), immunoadsorption (IA), or double filtration plasmapheresis (DFPP) in 12 European pediatric nephrology units during 2012.

Results

Sixty-seven children underwent PE, ten IA, and three DFPP, for a total of 738 PE and 349 IA/DFPP sessions; 67.2 % of PE and 69.2 % of IA/DFPP patients were treated for renal diseases, in particular focal segmental glomerulosclerosis (FSGS), hemolytic-uremic syndrome (HUS), and human leukocyte antigen (HLA) desensitization prior to renal transplantation; 20.9 % of PE and 23.1 % of IA/DFPP patients had neurological diseases. Membrane filtration was the most common technique, albumin the most frequently used substitution fluid, and heparin the preferred anticoagulant. PE achieved full disease remission in 25 patients (37.3 %), partial remission in 22 (32.8 %), and had no effect in 20 (29.9 %). The response to IA/DFPP was complete in seven patients (53.8 %), partial in five (38.5 %), and absent in one (7.7 %). Minor adverse events occurred during 6.9 % of PE and 9.7 % of IA/DFPP sessions.

Conclusions

PE, IA, and DFPP are safe apheresis methods in children. Efficacy is high in pediatric patients with recurrent focal segmental glomerulosclerosis (FSGS), atypical hemolytic uremic syndrome (HUS), human leukocyte antigen (HLA) sensitization, and neurological autoimmune diseases.

Keywords

Pediatric apheresis Therapeutic apheresis Plasma exchange Immunoadsorption Double filtration plasmapheresis 

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Copyright information

© IPNA 2014

Authors and Affiliations

  • Fabio Paglialonga
    • 1
  • Claus Peter Schmitt
    • 2
  • Rukshana Shroff
    • 3
  • Karel Vondrak
    • 4
  • Christoph Aufricht
    • 5
  • Alan Rees Watson
    • 6
  • Gema Ariceta
    • 7
  • Michael Fischbach
    • 8
  • Gunter Klaus
    • 9
  • Tuula Holtta
    • 10
  • Sevcan A. Bakkaloglu
    • 11
  • Alexandra Zurowska
    • 12
  • Augustina Jankauskiene
    • 13
  • Johan Vande Walle
    • 14
  • Betti Schaefer
    • 2
  • Elizabeth Wright
    • 3
  • Roy Connell
    • 6
  • Alberto Edefonti
    • 1
  1. 1.Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Pediatric NephrologyUniversity Hospital for Pediatric and Adolescent MedicineHeidelbergGermany
  3. 3.Renal Unit, Great Ormond Street Hospital for ChildrenLondonUK
  4. 4.University Hospital MotolPragueCzech Republic
  5. 5.Department of Pediatric Nephrology and GastroenterologyMedical University of ViennaViennaAustria
  6. 6.Children’s Renal & Urology Unit, Nottingham Children’s HospitalNottinghamUK
  7. 7.Pediatric Nephrology,Hospital Universitario Vall d’HebronBarcelonaSpain
  8. 8.Hopital HautepierreStrasbourgFrance
  9. 9.Renal Unit, KfH Pediatric Kidney CentreMarburgGermany
  10. 10.Department of Pediatric Nephrology and Transplantation, Hospital for Children and AdolescentsUniversity of HelsinkiHelsinkiFinland
  11. 11.Department of Pediatric NephrologyGazi University HospitalAnkaraTurkey
  12. 12.Gdansk University Hospital Medical SchoolGdanskPoland
  13. 13.Renal Unit, Vilnius UniversityVilniusLithuania
  14. 14.Department of Pediatric NephrologyUniversity HospitalGhentBelgium

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